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New Patients

What To Expect

Your first visit to George & Koch Dental Associates establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor. To understand what to expect for your first visit to our practice, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. 

Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you; as such, we ask you to arrive 10-15 minutes prior to your appointment in order to fill out health history forms and a confidentiality notice. You may also wish to review our staff page and familiarize yourself with the doctors and staff. We look forward to your first visit!


NOTICE OF PRIVACY PRACTICES 

This Notice describes how you and your dependent(s)’ medical, dental, and personal information may be used and disclosed by our office. The use of the first-person (“we”, “us”, etc.) refers to George and Koch Dental Associates; the use of the second-person (“you”, “your”, etc.) applies to anyone who seeks care from us. “PHI” refers to your personal health information. 

 If you have questions or would like additional information about this Notice, you can contact Dr. George, Dr. Koch, or one of our receptionists at: 

(802) 476-4812 

or 

George and Koch Dental Associates, PC 

6 North Street 

Barre, VT 05641-3810

 or 

[email protected] 

We are required by law to maintain the privacy of your PHI, to notify you of our privacy practices and your rights with respect to such information, and to abide by the guidelines contained in this Notice and subsequent updates to it. We reserve the right to make changes to this Notice at any time, provided such changes are within the law, and such changes will apply for all of your PHI in our possession, whether that information was created before or after changes to this Notice. You have the right at any time to request a copy of the current Notice, but we are under no obligation to proactively inform you of changes. All iterations of this Notice shall apply at current and future times unless recent changes rescind prior practices. The current version of this Notice is dated June 25, 2018. 

This document applies both to you and to any minor dependents or persons for whom you are legally responsible that are listed on your account, and it applies to any such individual(s) you may later add to your account. This authorization expires for such dependents when they either reach the age of 18, legally emancipate, or legal guardianship is changed or terminated. It is your responsibility to inform such individuals that they should contact our office immediately upon the date of any such occurrence so that they can read this document and execute authorization on their own behalf. This Notice is not normally the first thing that a parent thinks of the morning a child turns 18, but it is almost impossible to avoid situations where a child has recently turned 18 and a parent is reminded of this child’s upcoming appointment, or where treatment is rendered before a child turns 18 and the parent receives the bill after the birthday. We kindly ask your help so we may do our best in this regard.

HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION 

The following examples describe different ways we may use or disclose your PHI. This is not meant to be an exhaustive list. We are permitted by law to use and disclose your health information for the following purposes, and others that may not be listed here or in sufficient detail: 

Treatment: You authorize us to communicate relevant patient information with our trusted partners in care. This includes, but is not limited to, specialists, labs, consulting experts, our accountants and attorneys, and our computer and technology support teams. This means we will share your information to the extent needed to render care professionally, safely, and optimally. These partners are obliged by law to protect your PHI to the same extent that we are.

Payment: You authorize us, should we choose to do so, to bill your insurance on your behalf and release any relevant information your company demands. You also authorize us to note on your insurance claims that you have authorized insurance payment directly to us for your convenience. 

Communication: You authorize us to communicate with you using modern technologies. This includes email, live or automated voice communication, via telephone land lines, home answering devices, text messages, postcards, letters, and other means. These communications will not be encrypted and should not be considered to be “secure”.The content of such communications will generally be as limited as necessary in order for our relationship to function. Examples of such communication are: electronic billing statements, appointment reminders, prompts to fill out electronic forms we deem necessary and those forms themselves; this list does not limit content, but illustrates the sort of communication necessary for us to serve you properly and efficiently. 

*If you are a non-dependent or an over-18 offspring who remains on one or both parents’ medical or dental insurance policies, you authorize us to continue to communicate with your parents regarding appointments, billing, treatment, and possibly other relevant topics. This is often necessary if you are away at college, you have not updated or provided us with current contact information, or if your folks are still paying your dental bills. If you wish to not allow this, you must inform us that you wish to create your own account and that you will handle insurance claims submission and resolution on your own, and will pay us directly. Federal law allows adult children to remain on their parents’ insurance until age 26, and it is impractical for us to separate billing and insurance when all parties are covered by one subscriber. We appreciate your help with this. 

*If you are an adult and are listed on another person’s insurance plan, or if that person is listed as the Responsible Party or Head of Household for your account with us, you authorize us to communicate with that person for billing, insurance, and appointments. 

Business Operations: We may use your PHI as necessary to operate smoothly as a business entity. Such things as internal audits of care, financial reviews or audits, training, quality assurance, legal matters, accreditation, licensing, and business planning often require the use of PHI. Again, your PHI remains confidential within the scope of applicable law. 

Education and Research: You authorize us to use your medical information for educational purposes, so long as reasonable efforts are made by us to protect your identity. Normally this means not revealing more than a full smile and lips in photographs, not using other identifying image metadata, and limiting case information to what is necessary for the purpose at hand. Full names, addresses, etc. are never used. Drs. George and Koch participate in study clubs, conferences, and teaching events where case studies are relevant to share with colleagues and students.

Interaction with Family, Friends, and Persons Involved in your Care: We may disclose pertinent PHI to such individuals if necessary to render professional care for you. Examples of this include your incapacitation, time-critical situations or emergencies, or routine practices such as family members making appointments for others; picking up prescriptions, medical supplies, x-rays, referral documents; or, conducting financial business. In all such circumstances we will use our professional judgement and limit release of your PHI to such things that are pertinent to the situation. 

Marketing: You are NOT required to consent to marketing uses. Any photos, films, or other anonymous patient data used in marketing will first be discussed verbally with you, and a chart note will be made if you give permission for marketing use. Normally this means showing before and after photos of teeth and lips with a brief description of treatment on our website gallery. If you decline such verbal permission, we will NOT use any of your data for marketing, and we will notate your preference in your chart. 

Less Common Uses of PHI: 

—Disclosures required by law: There are certain circumstances where health professionals are required to cooperate with government agents and entities. This includes such things as oversight agencies, government benefit agencies, civil rights enforcement, or HIPAA compliance. 

—Public health activities: Such activities include preventing or controlling outbreaks of disease, injury, or disability; reporting of births or deaths; reporting domestic abuse, child abuse, or child neglect; reporting adverse reactions to medications or procedures; reporting product defects or enabling product recalls; and, notification if a patient has potentially been exposed to a disease or other previously unknown risk.

—Legal actions, lawsuits, court orders, and other law enforcement activities require our cooperation by law.

—We must cooperate with medical examiners, coroners, and funeral directors in the execution of their duties.

—Cooperation with organ or tissue donation procedures is required if you are an organ donor or if you have received a human tissue donation.

—To lessen a serious threat to your safety or the safety of others, we may disclose certain PHI.

—Cooperation with Workers’ Compensation or similar entities can require the use of PHI in the disposition of a claim.

—Specialized Government Functions: We may have to disclose PHI if you are in the military, public service, Secret Service, require it for a security clearance, or if you are incarcerated or under arrest or indictment. We may also disclose your PHI in matters of national security. 

Your Rights with respect to your PHI: 

You have the following rights with respect to you PHI. To exercise any of these rights you must contact us as noted above in writing and either sent Certified Mail or delivered in person. 

—You may request to access and review a copy of your PHI. We may deny your request under certain circumstances, in which case you will receive a written response and be entitled to appeal the decision. We will provide you a copy of your PHI in the format you request if it is practical to do so. If it is not, we will provide either electronic copies or paper documents. We may request a fee for extraordinary or time-consuming requests.

—You may request amendments to your record if you believe it is incorrect or incomplete. We may deny your request under certain circumstances, and you will be given written notice of the the denial. You can file a statement of disagreement that will be included in your record.

—You may request that we restrict some of the access described in this Notice. We may or may not agree to such restrictions, and we are not required to do so under the law. There is one exception to this, and that is if you pay in full for your services, you have the right to require us to not submit information to your insurance company.

—You may request to receive communication of your PHI by alternative means or at an alternative location. We will accommodate such a request if it is reasonable and there is reason to believe your safety depends on it. You need to submit such a request in writing and provide appropriate information for us to comply.

—You have a right to an accounting of disclosures of your PHI for up to six years prior to the date of the request, except for disclosures to carry out treatment, payment, health care operations, and certain other exceptions enumerated by HIPAA. The first accounting we provide for any twelve-month period will be at no charge, but we may charge a reasonable fee for subsequent requests for the same period. You will be informed of the charges and may withdraw your request if you choose.

—You have a right to a paper copy of this Notice.

—You have a right to file a written complaint about potential violations of HIPAA-required PHI protections. You would file this with the Office of Civil Rights at the U.S. Department of Health and Human Services. We will not retaliate against you for such actions.

—We are required by law to notify you if the privacy or security of your PHI has been breached. This notification will occur by mail within sixty days of discovery of the breach, and will contain a description of what occurred, including the dates of breach and discovery of it; recommended steps you should take to protect yourself from potential harm arising from the breach; and, a brief description of what steps we are taking to mitigate the consequences and prevent future breaches. 

Special Protections: Certain Federal, State, and local laws may require special privacy protections of PHI. Examples of this are HIV status, substance abuse history, mental health history, and genetic information. If you believe you are entitled to a special protection under applicable law, you must inform us accordingly in writing.

This Notice is designed to provide you with a detailed overview of how your personal healthcare information is used by us. This is not an exhaustive list; rather, it is a good faith effort at informing you how information sharing is necessary for us to render care and be reimbursed for it. The guiding principle is that your PHI is a vital part of your care, and it will be disclosed as needed to render that care and as allowed under law. It is your right to inform us of any practice that you believe violates this Notice, but you also agree we are entitled to an opportunity to discuss this with you and attempt to come to a fair resolution. You are not required to sign this document; your signature is merely acknowledgement of receipt of this Notice, and does not grant or limit our right to use your PHI as described in it.

Office Hours 

Treatment is by appointment, Monday through Friday, 8:00am to 5:00pm. Appointments for 7:00am are available on a limited basis. For schedule changes we request a 24-hour notice.

Emergencies

We do our best to accommodate emergencies promptly. In the event of an emergency during the work day, please call our office to inform us of the individual involved and the nature of the concern. This will help us to provide care more efficiently and effectively. After hours, our automated receptionist will give instructions to put you in touch with your regular dentist or one of the associates.

Referrals

Our practice is mostly referral-based. This means that we have someone to thank for sending you here for care. It means we welcome your family and friends also.

A practice which grows via word of mouth is a true privilege. Your total satisfaction, therefore, is our primary goal.

Financial Policies

Cost estimates are available prior to treatment when requested by the patient. Please be certain you understand options and costs prior to care. Payment options are:

  1. Cash or check.
  2. VISA, Mastercard, Discover.

Monthly payments are easy with our automatic credit card authorization. Just ask us.

Since most all dental plans have deductibles, we require same-day payment in full for all emergency care of first-visit patients.

We will assist you with your insurance claim. We advise that you assign payment of benefits to our office to ease the cash flow of your obligations. Please know that insurance is your benefit, not ours, and that responsibility for payment is ultimately yours. This is true even if a properly submitted claim is denied. With over 700 groups currently in our database, we cannot vouch for the outcome of every claim nor for the process and policies of every insurance company.

Coverage varies by type as well as by group plan. For simplicity we require 50% of the fee be paid at the time of each visit, except for preventive and diagnostic services, which are usually covered at 100%. After insurance processing we will bill you for any difference or refund any overpayment. Expensive and lengthy plans may require a customized plan or fee payment.

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